Minor's Personal and Artwork Release agree, on behalf of myself and child __ that my child and the artwork. created by my child, titled (“Artwork”) may be filmed, videotaped and photographed by you, and that his/her voice may be recorded by you, in connection with Your program, Art in the Village and USC Neighborhood Outreach (the *Prograin(s)") and thatthe film, Videotape and sound recordings and other photographs made by you may be used with such narration and. other materials (including other recordings and photographs) as you may deem appropriate. Furthermore, agree on behalf of myself and my child, that my child’s name, likeness, school, grade level, and age may also be used in connection with the Ariwork and the Program. So far as my child and I are concerned, you will have the right to broadcast, distribute, exhibit, ‘merchandise, and otherwise use the Artwork forever, throughout the world in all media in connection with the Program(s) and in advertising and publicity for the Program(s), 2s well as in connection with other programs. In no case will any consideration or additional consent be required to permit your use of the Artwork, | represent and warrant that my child's acts and statements included in the Program(s) will not violate any right of any other person or company and that the Artwork is wholly original with my child. Furthermore { Fepresent and warrant that I am the mother! father (circle one) of my child and histher legal guardian, and that I have the right to give this consent on his! her behalf. ‘understand that this agreement does not obligate you to use any of the Artwork, or to exercise any rights ranted in this consent. Signal ‘Signature (parent) School Printed Name (parent) fs Date of Birth et Adress Date Gity, State and Zip Code Home Phone